Will Quality Be A Casualty Of The Health-care Crisis?

The need for surgery was urgent, the threat to his survival without it considerable. The operation was long and difficult, but reasonably safe done in a good hospital by a highly competent surgeon.

Who thinks about comparing prices or shopping around for a deal in the face of such anxiety and stress?

Then his recovery was dicey. The heart needed painstaking attention. The lungs faltered in their function. The vital balance of oxygen in the blood slipped. Day after day after scary day, the respirator sustained his life. Hour after tense hour, the competent and caring nurses in the intensive care unit checked and rechecked the beeping monitors, kept a dozen bags of medications dripping into IV lines, anticipated and guarded against further complications.

How can a nurse's salary pay for such skill, such indefatigable effort, the bearing of so much unrelenting stress?

The skills of pulmonary specialists were needed often, once at a scary time near midnight. So were those of a cardiologist and his partner, a gastroenterologist, a radiologist and a neurologist, their competencies coordinated by a superb internist.

How much is too much to pay for knowing what to do when a life is at stake?

Twenty-four hours a day, respiratory therapists helped with his breathing and monitored the oxygen level in his blood. X-rays and CAT scans checked for the pulmonary embolisms when symptoms suggested the possibility. Finally, when he was freed from the respirator and released from intensive care, physical therapists helped him begin to regain his lost strength and get ready to come back home.

The costs of such care are obviously horrendous. But even in retrospect, when most of the fear has abated, all of it seems justified, part of an integrated effort to sustain a life in jeopardy. That life would have been lost five years ago, without today's technology and skills, someone told the man's family during the anxious days after surgery.

Thousands of medical case histories more dramatic than this are written every week in U.S. hospitals, of course. Most of us take it for granted that should we need life-saving care, it will be instantly there for us: specialist doctors, expensive equipment, wonder drugs, competent and caring nurses and therapists in a supportive and healing hospital.

What we don't want to do, what we are afraid we couldn't possibly do, what we don't even dare to think about when we are pacing the corridors outside of intensive care is paying for it all. Certainly, when it is someone we love who needs a CAT scan, another specialist, more days in intensive care, more therapy, we are in no position to behave as prudent, comparison-shopping consumers.

That makes us fair game for the political candidates who are promising to do SOMETHING about health-care costs and for the legislators, think-tank experts and medical associations now pushing dozens of national health-care plans.

But before we sign on to any political promises or drastic proposals, we must be sure we will not lose the access to health care that most of us now have, that its quality will not be jeopardized and our freedom to make our own decisions about medical care will not be compromised.

The demands for change are fueled largely by two intractable problems: Despite dozens of cost-saving strategies, the bill for the nation's health care continues to grow relentlessly, taking 12.2 percent of the GNP - $756 billion this year - and overburdening not only employers but federal and state governments as well.

And about 35 million people, many of them low-income workers, lack health insurance; the cost of what care they do get is usually shifted onto the bills of others, pushing up the rates charged by hospitals and other providers even higher.

But many of the current proposals being touted to solve these problems could, in effect, limit the access most of us would have to optimal, high-quality care. Plans calling for ''basic health care for everyone'' are often code words for rationing. They can mean either overt refusal to pay for certain kinds of treatments or restrictions by age or severity of illness, or they can involve de-facto rationing by waiting lines or inadequate investment in sophisticated new technology.

Several proposals involve more ''managed care,'' such as expanded HMOs or much larger groups organized to negotiate fixed rates with hospitals, physicians and other health-care providers. They raise concerns that individuals will be restricted too much in their access to more expensive kinds of care and both they and the providers will lose control over personal health-care decisions.

Those of us who now benefit from high-quality medical care do have an obligation to make sure it is available to all. And obviously, unless costs can be contained more effectively, the bills for all of us - including higher consumer prices and higher taxes-will be unbearable. But in trying to solve these problems, the politicians and the experts must remember that what sounds good in theory won't be tolerated if it undermines the great strengths of the current system.